Infants’ and children’s mental health (more than that of any other age group) is tied to the world around them. A child’s relationships; home, school and neighbourhood environments; and the broader societal and economic context they live in all have an impact on their development and wellbeing.
As a practitioner working with children or parents, it is important to understand the hopes, preferences and values they have for their relationships with others, so that you can offer them the most effective support. In this way, you can be curious about what makes up the child’s best possible ecology, and how you can support this to become reality.
You may have heard of the social ecological and biopsychosocial models of health (Bronfenbrenner, 1994; Engel, 1977). These models can be used as frameworks to consider all the potential influences on infant and child mental health: family and peer relationships; home, school, neighbourhood and community environments; and the wider social, economic, political and cultural factors (e.g. racism, ableism, poverty) a child is exposed to.
It’s important to remember that each factor is important to the child’s overall mental health, development and wellbeing. Changes in one area of a child’s life can lead to changes in other areas. This means that even if you work in an adult-focused service, you can help to support children’s mental health and development by exploring how any challenges the parent is facing may be affecting the child’s home, school or social life.
This ‘whole child’ approach is especially useful in supporting the mental health of children with disability. Asking questions about the child’s ecology can help you to look beyond their medical diagnosis, to better understand and support their needs, strengths and hopes, along with their relationships with family, friends and the wider community.
The following video (2 minutes 25 seconds) unpacks this holistic view of children’s social and emotional wellbeing.
Once you have a picture of the ‘whole child’, you can begin to explore ways to use these different factors to tackle the problems they’re facing. If you work with children, the ‘best life’ activity is a fun, engaging way to do this.
This exercise asks children to imagine and describe what their ‘best life’ would look like. It can help children and families to consider what they want from their lives, what’s most important to them, and the ways that the problem is getting in the way.
The following fictional demonstration (2 minutes 34 seconds) shows a practitioner using the ‘best life’ exercise to build rapport with Zoe and her mother, Brigid.
Children’s skills, values and know-how are shaped by the people, communities, cultures and relationships that surround them. The ‘best life’ exercise can help children to identify these strengths and how they use them in their everyday life. It views children as active participants in shaping their own lives; and helps children and parents to examine the situation from their own perspectives, rather than simply relying on your professional opinion.
The ‘best life’ exercise takes away any judgement or expectation about the child’s behaviour. Instead, it focuses on their individual preferences, skills, interests and values. It can be a more hopeful way of exploring the child’s ecology, by highlighting the aspects of their life that sustain and energise them and all the ways in which they’re already living their ‘best life’. It can also help to reframe individual characteristics that may have previously been viewed as ‘problematic’, in a more positive way.
This activity can be especially useful if the child is hesitant to meet with you. It can help children to let go of any worries they may have about what they’re doing wrong, or how you’re going to ‘fix’ them, and instead just focus on the activity. If the parent is reluctant to participate or expects you to just ‘fix’ their child, activities such as the ‘best life’ exercise can help to engage them in the therapeutic process.
In the following video (3 minutes), clinical psychologist Penny Sih shares how she uses the ‘best life’ exercise in her work with children.
A child’s family has the most powerful and enduring influence over their development, physical and mental health, and wellbeing (Walker, 2021). Research shows child mental health interventions are more likely to be effective when parents are explicitly included in the process (Ingoldsby, 2010; Haine-Schlagel et al., 2018).
Parents can be a valuable source of information and encouragement. They may be able to identify skills or aspects of their child’s ‘best life’ that the child hadn’t thought of themselves, and they can remind and encourage the child to apply your strategies in their everyday life.
In the following video (1 minutes 48 seconds), psychologist Penny Sih and mental health social worker Ali Knight share how they approach developing a team around the child.
Children thrive when their parents and caregivers are supported. A key part of understanding a child’s ecology is getting an idea of their family’s support network, along with the type of support (informational, practical or social) that would best suit their needs. Social support systems are critical to help counteract family stress and promote positive mental health and wellbeing (Henderson, Schmus, McDonald, & Irving, 2020), but parents may also benefit from other sources of support.
But while a strong, stable parent-child relationship is an important foundation for mental health and resilience, children also need a supportive team around them. This includes their immediate family, their friends, and other trusted adults such as educators, community leaders and healthcare providers.
These external social supports are especially important for children who are experiencing adversity. They offer a sense of connection, safety and security that the child may not be able to find at home (Henderson et al., 2020; Hosokawa & Katsura, 2020).
An understanding of the child’s social ecology can also help you to identify the different ‘situational experts’ in their life. In their various contexts, these people – the child themselves, their family, peers, teachers, GP, sporting coach, etc. – know the child better than anyone else. They can help you to gain a better understanding of the presenting problem by establishing whether issues are occurring in specific situations or across multiple contexts.
Children’s mental health and development is shaped by the physical environments in which they live, learn and play.
Infants and toddlers spend much of their time at home and in their local neighbourhood. Access to parks, playgrounds and ‘social infrastructure’ (health, education and other services) provides children and parents with opportunities to connect with other young families and strengthen their local support networks (Strange, Fisher, Howat, & Wood, 2014). As they start school, children begin to interact with a wider variety of people and settings, spending more time outside of their home environment.
Research has shown children of all ages benefit from living in areas with good-quality housing and playgrounds and easy access to community services (Alderton et al., 2019), while exposure to nature can reduce stress and improve attention (Markevych et al., 2017). However, children from disadvantaged families are less likely to have access to these kinds of neighbourhoods (Astell-Burt, Feng, Mavoa, Badland, & Giles-Corti, 2014; Cloney, Cleveland, Hattie & Tayler, 2015).
The Healthdirect Service Directory can help you to identify and connect families with services in their local area. Promoting children’s exposure to nature and involvement in community services can complement any strategies to prevent mental health difficulties and support their social and emotional wellbeing. You can also help by advocating for policies that consider children’s mental health and psychosocial wellbeing in the planning of neighbourhood environments.
Understandings of child ecology go hand-in-hand with understandings of intersectionality. Societal structures can reinforce the complex, cumulative impacts of racism, sexism, classism, and other forms of discrimination, leaving some families more disadvantaged than others. They place greater stress on families and increase the likelihood of adverse childhood experiences (ACEs) occurring.
These societal structures are often referred to as the ‘social determinants of health’. They include:
- income and social protection
- employment and job security
- working life conditions
- food security
- housing, basic amenities and the environment
- early childhood development
- social inclusion and non-discrimination; and
- access to affordable, decent-quality health services (WHO, n.d.).
You can help children and families by increasing awareness of how these factors intersect to influence children’s social and emotional wellbeing, and by advocating for policy changes to address the structural drivers of mental ill-health. Systemic changes which provide disadvantaged families with access to resources such as stable job opportunities and affordable housing, are the key to improving children’s short- and long-term outcomes (Henderson et al., 2020).
No matter the kind of service you work in, you can play a role in supporting infants’ and children’s mental health. A solid understanding of child ecology – the different factors that influence children’s social and emotional wellbeing and development – can help you to keep the child in mind when working with parents and families. This knowledge will also help you to find the best prevention and early intervention strategies to suit a child’s needs.
Alderton, A., Villanueva, K., O’Connor, M., Boulangé, C., & Badland, H. (2019). The role of neighbourhoods in young children’s mental health: what does the evidence tell us? Adelaide: Emerging Minds.
Astell-Burt, T., Feng, X., Mavoa, S., Badland, H.M., & Giles-Corti, B. (2014). Do low-income neighbourhoods have the least green space? A cross-sectional study of Australia’s most populous cities. BMC Public Health, 14, 292.
Bronfenbrenner, U. (1994). Ecological models of human development, in International Encyclopedia of Education, Vol. 3, 2nd. Ed. Oxford: Elsevier.
Cloney, D., Cleveland, G., Hattie, J., & Tayler, C. (2015). Variations in the availability and quality of early childhood education and care by socioeconomic status of neighborhoods. Early Education and Development, 27, 384–401.
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136.
Haine-Schlagel, R., Martinez, J., Roesch, S., Bustos, C., & Janicki, C. (2018). Randomized trial of the parent and caregiver active participation toolkit for child mental health treatment. Journal of Child & Adolescent Psychology, 47(1), 150–160.
Hosokawa, R., & Katsura, T. (2020). The relationship between neighborhood environment and child mental health in Japanese elementary school students. International Journal of Environmental Research and Public Health, 17, 5491.
Ingoldsby, E. (2010). Review of interventions to improve family engagement and retention in parent and child mental health programs. Journal of Child Family Studies, 19, 629–645.
Markevych, I., Schoierer, J., Hartig, T., Chudnovsky, A., Hystad, P., Dzhambov, A. M., … Fuertes, E. (2017). Exploring pathways linking greenspace to health: Theoretical and methodological guidance. Environmental Research, 158, 301–317.
Strange, C., Fisher, C., Howat, P., & Wood, L. (2014). Creating a village in modern suburbia: Parenthood and social capital. Urban Policy Research, 33, 160–177.
World Health Organisation (WHO). (n.d.). Social determinants of health.